Endodontic instruments are used in dentistry to treat tooth cavities.
Treatment is particularly difficult canals of teeth: their shape and diameter require dental instrument manufacturers to combine incongruous combinations such as flexibility and strength combined with cutting ability.
This is the reason for the variety of instruments for treatment endodontist: in the case of a specific device, you have to sacrifice something, and therefore for the same manipulations can be used tools that are different not only in size and shape, but also in basic destination.
Content
- Endodontic instrument standardization
-
Types of tools
- Diagnostics
- Expansion of the canal mouth
- Removal of soft tissue
- Channel passage
- Root canal enlargement
- Root canal filling
Endodontic instrument standardization
The abundance of endodontic instruments in dentistry has made their standardization extremely urgent. After the introduction of the ISO standard in this area. For example, dimensions are indicated by the color of the handle:
Handle color | The size |
---|---|
Pink | 06 |
Gray | 08 |
Purple | 10 |
White | 15, 45 and 90 |
Yellow | 20, 50 and 100 |
Red | 25, 55 and 110 |
Blue | 30, 60 and 120 |
Green | 35. 70 and 130 |
Black | 40, 80 and 140 |
Color-coding turned out to be extremely convenient for dentists because when working with canals, the size of the instruments should increase sequentially, while for sealing, devices should be used one size smaller than expanders.
Thanks to standardization, now, instead of looking at the markings in small numbers, the doctor can simply notice the pen of the desired color.
In addition, for standardized instruments, the length of the working part, section and taper are marked. All this is indicated on the handles with certain symbols, and helps the doctor to easily navigate the devices.
Types of tools
By appointment, endodontic instruments in dentistry are:
- Providing access to the tooth cavity and helping to find the mouth of the root canals.
- Expanding the mouth of the root canals.
- Reamers - for the passage of root canals.
- Files - for their expansion and alignment.
- For pulp extraction.
- Root canal meters.
- Channel fillers.
- Auxiliary.
Diagnostics
To correctly select the size of endodontic instruments in dentistry for the treatment of a particular tooth, the following devices are used.
- Miller's Root Needle - diagnoses the patency and direction of the root canal.
- Depth gauge - measures the length of the root canal.
- Verifer - helps to choose the size pin from gutta-percha. Used when filling materialsthat need to be reheated.
Expansion of the canal mouth
In most cases, the mouth of the root canal is narrower than the rest of its parts. This makes it difficult to administer both instruments and drugs. To solve this problem, it is necessary to widen the mouth. Previously, small spherical bora, but their use often led to a complication: destruction of the wall of the root cavity. Avoid this, for example, bora gates-glidden (450-800 rpm), Orifice Opener and Beutelrock Reamer B2.
They work only on straight sections; in curved sections, the likelihood of complications is high. The Beutelrock Drill reamer B1 is considered less aggressive.
Orifice Bur burs (a bit like gates-glidden), Ambler, Krause and others are also used to widen the mouths.
Reamer Peeso Reamer (largo) is more functional and rotational speed (700-1200 rpm). They can also carry out the next stage of processing - go through the straight canal of a single-rooted tooth, prepare it for a pin or unseal his.
Removal of soft tissue
This group of devices is called pulp extractors, hand held disposable thin serrated metal rods.
The points of the teeth are directed towards the handle, so it penetrates well into the canal, turns in it to hook the pulp, and is carefully removed.
If the pulpextractor jams, most likely, it will break off, so you need to be careful that the device passes freely, insert it into narrow channels no further than 2/3. If the pulpextractor cannot cope with the task, they use root rasps, K-files and H-files, in parallel expanding the cavity.
Channel passage
The manipulation begins with the use of K-files (K - from Kerr, the name of the first manufacturer of such devices). They are strong enough to bend due to the production method: twisting the workpiece. Medium and large K-files are usually triangular, small - square. Triangular reamers cut tissue better, but dull faster.
A typical representative of these drills is the K-Reamer, or drilbor. Due to its extended cutting edge, it is very flexible and has excellent cutting performance. The tip is non-aggressive, which allows the Kerr drill to glide without creating steps or perforations.
There are 20 sizes - from 08 to 140. The larger the size, the more careful you need to handle the instrument. Rotation angle up to 180 °, permissible movements - imitating the winding of a mechanical watch.
If you need an even more flexible device, use the K-Flexoreamer bur. It comes in 6 sizes - from 15 to 40 in increments of 5. It happens that such a difference between tool sizes is too great, and then you can additionally take K-Flexoreamer golden medium. This is a similar example, but with intermediate sizes (from 12 to 37 in increments of 5).
Consistent use of both of these devices eliminates the risk of jamming. Disadvantage: the use of intermediate tools increases the cost of treatment.
If it is difficult for the patient to open his mouth wide and at the same time he has narrow channels, K-Reamer Farside and K-Reamer Deepstar are used. These are short (15-18 mm) inflexible reamers with a thin tip. The first set contains sizes 06, 08, 10 and 15, the second from 20 to 60.
To find and pass complex canals - thin, curved, calcified - two models from Kerr are good. This is a Pathfinder drill - thin, with a pointed tip, a slight taper and sharp cutting edges.
The device is quite aggressive and requires careful handling. Similar to it is the Pathfinder CS K-file, which comes in two sizes: K1 (07 ISO) and K2 (09).
Root canal enlargement
Although this manipulation can be done using K-files, files of type H (at the beginning of the name of the first manufacturer, Hedstroem) are more adapted to this.
A typical member of the family is the H-file, a circular hand tool with spiral cutting edges. It has the maximum cutting edge and longitudinal axis angle (60 °) and the largest number of cutting edges (31-41). The downside of the high efficiency of the H-file is its fragility, so it should be handled very carefully: try not to rotate it, and if you cannot do without it, rotate a maximum of a quarter turnover.
The H-file is used after the K-reamers or K-files, while taking the tool one size smaller than the previous one. With its help, the walls of the channels are smoothed and leveled. This drill is especially good if the gap is slit or oval.
There are safer modifications of the H-file to align the walls of curved canals. For example, the A-file, which has an atraumatic tip and deep grooves. Only treats the outside of the channel. The Safeti Hedstroem File, or Safe Drill, is also used. This is a smooth side modification of the H-file. It can be used to process curved canals without changing their shape.
All of these instruments cannot be rotated in the channel, but there is a modification that is capable of neat rotation. This is S-File. It got its name from the double helical cutting edge, which determines the cross section of the file in the form of the letter S. Due to the shallower groove depth, this tool is stronger than the H-file.
Root canal filling
This is the most diverse category of endodontic instruments in dentistry. In fact, every new method of filling with heated or thermoplasticized gutta-percha implies the emergence of new devices.
For filling with pasty materials, mechanical and manual canal fillers are used. The rotation speed is small, 100-200 rpm. The size of the filler should be slightly smaller than the diameter of the last used retractor.
This will avoid jamming the tool and creating an air-filled cavity. Typically, the fillers are wire coils. This shape also prevents air bubbles from remaining inside the filling material.
The most typical representative of the family is the canal filler L (after the name of the inventor, the Frenchman Lentulo).
A Spreader lateral condenser is used to seal the gutta-percha posts. It is a hand instrument, round in cross section, with a pointed tip. Spreader injected into the installed pin, advance it to the border between the pulp and the periodontium and press it against the canal wall.
Pluggers are used for vertical compaction of gutta-percha. According to the shape of the handle, they are subdivided into finger and hand. With the aid of the device, with gentle movements towards periodontium tamp the filling material.
Modern gutta-percha, as a rule, requires heating to increase plasticity and better fill the cavity. For this, for example, a Heat-carrier is used, which has 2 types of working part: a heated spreader softens the filling material, and a plugger seals it.
The gutta condenser allows you to condense the gutta-percha by the thermomechanical method. The gutta condenser is similar in shape to an inverse H-file. They soften the gutta-percha by rotating the instrument at a speed of 8-10 thous. rpm The heated material flows down to the border of the pulp and periodontium, where it thickens.
Presentation on the topic "Endodontic Instrumentation":
Endodontic instruments in dentistry are a rapidly growing field. Every year, at the congresses of dentists, new products from this field are presented, thanks to which the treatment of pulp diseases becomes more and more comfortable for both doctors and patients.
Most of the new products appear among canal fillers, although other endodontic instruments are also being improved. With the introduction of the ISO standard, the selection of instruments for the dentist has become much easier both at the stage of selecting devices and during their use.
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